MEDICARE: MR. WILLIAM HENRY HARRISON CHAPMAN IV MPH, RD, RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	L005349	NC

General Provider Information

NPI Number	:	1063925345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM HENRY HARRISON CHAPMAN IV MPH, RD, RDN

Provider Business Mailing Address
First Line	:	3404A ELLSWORTH DR
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-2133
Country	:	US
Telephone Number	:	252-414-4054
Fax Number	:

Provider Business Practice Location Address
First Line	:	3404A ELLSWORTH DR
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-2133
Country	:	US
Telephone Number	:	252-414-4054
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2017
Last Update Date	:	03/17/2018

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